Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis

Abstract

Bones are the third most common location for solid tumor metastasis affecting up to 10% of patients with solid tumors. When the spine is involved, thoracic and lumbar vertebrae are frequently affected. Access to spinal lesions can be through minimally invasive surgery (MIS) or traditional open surgery (OS). This study aims to determine which method provides an advantage. Following the PRIS-MA (Preferred Inventory for Systematic Reviews and Meta-Analysis) guidelines, a systematic review was conducted to identify studies that compare MIS with OS in patients with spinal metastatic disease. Data were analyzed using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). Ten studies were included. Operative time was similar among groups at -35.23 minutes (95% confidence interval [CI], -73.36 to 2.91 minutes; p=0.07). Intraoperative bleeding was lower in MIS at -562.59 mL (95% CI, -776.97 to -348.20 mL; p<0.00001). OS procedures had higher odds of requiring blood transfusions at 0.26 (95% CI, 0.15 to 0.45; p<0.00001). Both approaches instrumented similar numbers of levels at -0.05 levels (95% CI, -0.75 to 0.66 levels; p=0.89). We observed a decreased need for postoperative bed rest at -1.60 days (95% CI, -2.46 to -0.74 days; p=0.0003), a shorter length of stay at -3.08 days (95% CI, -4.50 to -1.66 days; p=0.001), and decreased odds of complications at 0.60 (95% CI, 0.37 to 0.96; p=0.03) in the MIS group. Both approaches revealed similar reintervention rates at 0.65 (95% CI, 0.15 to 2.84; p=0.57), effective rates of reducing metastasis-related pain at -0.74 (95% CI, -2.41 to 0.94; p=0.39), and comparable scores of the Tokuhashi scale at -0.52 (95% CI, -2.08 to 1.05; p=0.41), Frankel scale at 1.00 (95% CI, 0.60 to 1.68; p=1.0), and American Spinal Injury Association Scale at 0.53 (95% CI, 0.21 to 1.37; p=0.19). MIS appears to provide advantages over OS. Larger and prospective studies should fully detail the role of MIS as a treatment for spine metastasis.

Response to: Letter to the Editor, Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis

“…Dear Editor & Drs. Ali and Tariq, We appreciate your interest in our publication and the time taken to read and thoughtfully critique our work [1]. We believe in constructive criticism and cherish the opportunity to both address concerns raised by Drs.…”

Spinal metastasis: narrative reviews of the current evidence and treatment modalities

“… 92 , 93 Furthermore, spinal decompression can be done with minimal exposure via the mini-open midline approach, the use of tubular or expandable retractors and endoscopy. 13 – 15 , 92 , 93 …”

“… 13 – 15 Comparable changes in postoperative pain, neurological outcome, ECOG performance score, odds of survival and the rate of reoperation have been demonstrated in both open and minimal access surgery. 13 – 15 …”

“…In open surgery, studies suggest a delay of 14 days to 1 month after surgery before initiating adjuvant systemic treatment such as chemotherapy, radiotherapy and targeted therapies in order to minimize the rate of wound complications. 15 , 24 In patients that had undergone minimal access surgery, cEBRT may be started 1 week postoperatively and SRS may be initially immediately after the surgery. 73 , 94 , 95 …”

Letter to the Editor: Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis

“…Dear Editor, We with great interest read the article titled "Minimally invasive versus open surgery for spinal metastasis: a systematic review and meta-analysis" by Hinojosa-Gonzalez et al [1] published in Asian Spine Journal. The authors are commended for a well-written paper involving 10 studies with 577 participants.…”